scholarly journals Longitudinal Analysis of Macronutrient Composition in Preterm and Term Human Milk: A Prospective Cohort Study

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1525 ◽  
Author(s):  
Fischer Fumeaux ◽  
Garcia-Rodenas ◽  
De Castro ◽  
Courtet-Compondu ◽  
Thakkar ◽  
...  
Keyword(s):  
Human Milk ◽  
Energy Content ◽  
Male Gender ◽  
Total Protein Content ◽  
Macronutrient Composition ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Longitudinal Measurements ◽  
Potential Factors ◽  
Over Time

Background: Mother’s own milk is the optimal source of nutrients and provides numerous health advantages for mothers and infants. As they have supplementary nutritional needs, very preterm infants may require fortification of human milk (HM). Addressing HM composition and variations is essential to optimize HM fortification strategies for these vulnerable infants. Aims: To analyze and compare macronutrient composition in HM of mothers lactating very preterm (PT) (28 0/7 to 32 6/7 weeks of gestational age, GA) and term (T) infants (37 0/7 to 41 6/7 weeks of GA) over time, both at similar postnatal and postmenstrual ages, and to investigate other potential factors of variations. Methods: Milk samples from 27 mothers of the PT infants and 34 mothers of the T infants were collected longitudinally at 12 points in time during four months for the PT HM and eight points in time during two months for the T HM. Macronutrient composition (proteins, fat, and lactose) and energy were measured using a mid-infrared milk analyzer, corrected by bicinchoninic acid (BCA) assay for total protein content. Results: Analysis of 500 HM samples revealed large inter- and intra-subject variations in both groups. Proteins decreased from birth to four months in the PT and the T HM without significant differences at any postnatal time point, while it was lower around term equivalent age in PT HM. Lactose content remained stable and comparable over time. The PT HM contained significantly more fat and tended to be more caloric in the first two weeks of lactation, while the T HM revealed higher fat and higher energy content later during lactation (three to eight weeks). In both groups, male gender was associated with more fat and energy content. The gender association was stronger in the PT group, and it remained significant after adjustments. Conclusion: Longitudinal measurements of macronutrients compositions of the PT and the T HM showed only small differences at similar postnatal stages in our population. However, numerous differences exist at similar postmenstrual ages. Male gender seems to be associated with a higher content in fat, especially in the PT HM. This study provides original information on macronutrient composition and variations of HM, which is important to consider for the optimization of nutrition and growth of PT infants.

scholarly journals Impact of Infant and Maternal Factors on Energy and Macronutrient Composition of Human Milk

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2591
Author(s):  
Agnieszka Bzikowska-Jura ◽  
Piotr Sobieraj ◽  
Dorota Szostak-Węgierek ◽  
Aleksandra Wesołowska
Keyword(s):  
Human Milk ◽  
Energy Content ◽  
Correlation Coefficients ◽  
Milk Composition ◽  
Total Protein Content ◽  
Maternal Factors ◽  
Macronutrient Composition ◽  
Logistic Regression Models ◽  
Before And After ◽  
In Pregnancy

The present study investigates the influence of selected infant and maternal factors on the energy and macronutrient composition of mature human milk (HM). The study enrolled 77 mothers at 4–8 weeks postpartum. Each mother provided 1 sample of HM. Each extracted HM sample was formed by mixing four subsamples of HM, each of which were obtained in one predefined 6-h periods of the day. Among maternal factors, the analysis included: anthropometric data before and after pregnancy; weight gain in pregnancy; body composition, assessed using the Maltron BioScan 920-II to analyze bioimpedance; and dietary intake, assessed with three-day dietary records. Among the neonatal factors, birth weight and length, number of daily feedings and type of delivery were included. The composition of HM, including energy content, protein, fat and carbohydrate concentrations, was analyzed using the Miris human milk analyzer. Pearson’s and Spearman’s correlation coefficients and multivariable logistic regression models were used to analyze the association between the selected maternal and infant factors and HM milk composition. It was found that total protein content of HM was correlated with pre-pregnancy BMI (Spearman rho = 0.238; p = 0.037), current lean body mass (Spearman rho = −0.293, p = 0.01) and total water content (Spearman rho = −0.315, p = 0.005). Carbohydrates were the only macronutrients whose composition was significantly affected by the infant factors. It was reported that higher carbohydrate content was associated with male sex (OR = 4.52, p = 0.049). Our results show that maternal and infant factors, especially maternal pre-pregnancy and current nutritional status and infant sex, interact and affect HM composition, suggesting that macronutrient and energy content in HM may be determined in pregnancy and may have unique compositional profile for every mother–infant dyad.

scholarly journals Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol

2021 ◽  
Vol 18 (2) ◽  
pp. 823
Author(s):  
Manuela Cardoso ◽  
Daniel Virella ◽  
Israel Macedo ◽  
Diana Silva ◽  
Luís Pereira-da-Silva
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Fat Mass ◽  
Study Protocol ◽  
Milk Composition ◽  
Fixed Dose ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Pea Pod

Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

scholarly journals Cytotoxic Lactalbumin-Oleic Acid Complexes in the Human Milk Diet of Preterm Infants

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4336
Author(s):  
Katherine E. Chetta ◽  
Joseph L. Alcorn ◽  
John E. Baatz ◽  
Carol L. Wagner
Keyword(s):  
Oleic Acid ◽  
Human Milk ◽  
Preterm Infants ◽  
Frozen Storage ◽  
Lipid Complex ◽  
Acid Complex ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Milk Casein ◽  
Alpha Lactalbumin

Frozen storage is necessary to preserve expressed human milk for critically ill and very preterm infants. Milk pasteurization is essential for donor milk given to this special population. Due to these storage and processing conditions, subtle changes occur in milk nutrients. These changes may have clinical implications. Potentially, bioactive complexes of unknown significance could be found in human milk given to preterm infants. One such complex, a cytotoxic α-lactalbumin-oleic acid complex named “HAMLET,” (Human Alpha-Lactalbumin Made Lethal to Tumor cells) is a folding variant of alpha-lactalbumin that is bound to oleic acid. This complex, isolated from human milk casein, has specific toxicity to both carcinogenic cell lines and immature non-transformed cells. Both HAMLET and free oleic acid trigger similar apoptotic mechanisms in tissue and stimulate inflammation via the NF-κB and MAPK p38 signaling pathways. This protein-lipid complex could potentially trigger various inflammatory pathways with unknown consequences, especially in immature intestinal tissues. The very preterm population is dependent on human milk as a medicinal and broadly bioactive nutriment. Therefore, HAMLET’s possible presence and bioactive role in milk should be addressed in neonatal research. Through a pediatric lens, HAMLET’s discovery, formation and bioactive benefits will be reviewed.

scholarly journals Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial

2018 ◽  
Vol 44 (1) ◽  
Author(s):  
Simonetta Costa ◽  
Luca Maggio ◽  
Giovanni Alighieri ◽  
Giovanni Barone ◽  
Francesco Cota ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Donor Human Milk ◽  
Preterm Formula

scholarly journals Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

2018 ◽  
Author(s):  
Eduardo Villamor-Martínez ◽  
Maria Pierro ◽  
Giacomo Cavallaro ◽  
Fabio Mosca ◽  
Boris W. Kramer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Milk ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Observational Studies ◽  
Meta Analysis ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Donor Human Milk ◽  
Preterm Formula

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if mother’s own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCT’s could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (3 studies, risk ratio [RR] 0.89, 95% confidence interval [CI] 0.60–1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67–0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (3 studies, RR 0.80, 95% CI 0.68–0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (2 studies, RR 0.77, 95% CI 0.62–0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants, but pasteurization of human milk reduces the benefit.

Postnatal longitudinal reference growth of very preterm infants on exclusive human milk feeding till discharge

2020 ◽  
Vol 26 (6) ◽  
pp. 335-339
Author(s):  
Dinesh Pawale ◽  
Srinivas Murki ◽  
Dattatray Kulkarni ◽  
Avinash Kumar ◽  
Venakateshwarlu Vardhelli ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Milk Feeding

scholarly journals Development of macronutrient composition of very preterm human milk

1998 ◽  
Vol 80 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Yolande G. H. Maas ◽  
Jeanet Gerritsen ◽  
Augustinus A. M. Hart ◽  
Mijna Hadders-Algra ◽  
Jan M. Ruijter ◽  
...  
Keyword(s):  
Human Milk ◽  
Nutritional Value ◽  
Milk Composition ◽  
Macronutrient Composition ◽  
Total N ◽  
Very Preterm ◽  
Carbohydrate Concentration ◽  
Lactose Concentration ◽  
Gestational Age At Delivery ◽  
The Moment

The effects of gestational age at delivery (GA), postnatal age (PNA) and post-menstrual age (PMA=PNA+GA, an indicator of autonomous developmental processes not affected by the moment of birth) on macronutrient composition of very preterm milk were studied. Total N, fat, lactose and carbohydrate concentrations, energy density and 24 h volume were determined in 282 24 h milk samples collected at weekly intervals (days 7–55 of lactation) from seventy-nine women delivering their babies between 25 and 29 weeks of gestation. GA related differences were found for carbohydrate concentration only: carbohydrate concentration was lower with increasing GA. PNA was related to a decrease in total N and an increase in lactose concentration. PMA was not related to milk composition. Our data indicate that PNA strongly influences the development of the composition of very preterm human milk, while GA affects carbohydrate content with a negligible effect on the nutritional value of the milk. We conclude that in accordance with current opinion in paediatrics, human milk is the best source of nutrients even for very preterm (< 30 weeks GA) infants.

scholarly journals Growth of Very Preterm Infants in a Low-Resourced Rural Setting after Affiliation with a Human Milk Bank

Children ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. 80
Author(s):  
Chia-Huei Chen ◽  
Hui-Ya Chiu ◽  
Szu-Chia Lee ◽  
Hung-Yang Chang ◽  
Jui-Hsing Chang ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Rural Areas ◽  
Z Score ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Growth Outcomes ◽  
Milk Bank ◽  
Human Milk Bank ◽  
Milk Banks

The extrauterine growth restriction (EUGR) of very preterm infants has been associated with long-term complications and neurodevelopmental problems. EUGR has been reported at higher rates in low resource settings. There is limited research investigating how metropolitan human milk banks contribute to the growth outcomes of very preterm infants cared in rural areas. The setting of this study is located at a rural county in Taiwan and affiliated with the Taiwan Southern Human Milk Bank. Donor human milk was provided through a novel supplemental system. A renewal nutritional protocol was initiated as a quality improvement project after the affiliated program. This study aimed to compare the clinical morbidities and growth outcome at term equivalent age (TEA) of preterm infants less than 33 weeks of gestational age before (Epoch-I, July 2015–June 2018, n = 40) and after the new implementation (Epoch-II, July 2018–December 2020, n = 42). The Epoch-II group significantly increased in bodyweight z-score at TEA ((−0.02 ± 1.00) versus Epoch-I group (−0.84 ± 1.08), p = 0.002). In multivariate regression models, the statistical difference between two epochs in bodyweight z-score changes from birth to TEA was still noted. Modern human milk banks may facilitate the nutritional protocol renewal in rural areas and improve the growth outcomes of very preterm infants cared for. Establishing more distribution sites of milk banks should be encouraged.

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